Self-Regulation and Sleep Duration, Sleepiness, and Chronotype in Adolescents Judith A
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Self-Regulation and Sleep Duration, Sleepiness, and Chronotype in Adolescents Judith A. Owens, MD, MPH, a Tracy Dearth-Wesley, PhD, MPH,b Daniel Lewin, PhD, c Gerard Gioia, PhD,d Robert C. Whitaker, MD, MPHb, e, f OBJECTIVE: To determine whether shorter school-night sleep duration, greater daytime abstract sleepiness, and greater eveningness chronotype were associated with lower self-regulation among adolescents. METHODS: An online survey of 7th- to 12th-grade students in 19 schools in Fairfax County, Virginia Public Schools was conducted in 2015. Self-regulation was measured with the Behavior Rating Inventory of Executive Function, 2nd edition, Screening Self-Report Form. Sleep measures included school night-sleep duration (hours between usual bedtime and wake time), daytime sleepiness (Sleepiness Scale in the Sleep Habits Survey, tertiles), and chronotype (Morningness–Eveningness Scale for Children, continuous score and tertiles). Sociodemographic factors and mental health conditions were analyzed as potential confounders. RESULTS: Among 2017 students surveyed, the mean age was 15.0 years (range, 12.1–18.9 years), and 21.7% slept <7 hours on school nights. In regression models adjusted for confounders, there was a significant independent association between self-regulation and both chronotype (P < .001) and daytime sleepiness (P < .001) but not sleep duration (P = .80). Compared with those in the lowest tertile of daytime sleepiness, those in the highest tertile had lower (0.59 SD units; 95% confidence interval, 0.48–0.71) self-regulation, as did those in the eveningness tertile of chronotype compared with those in the morningness tertile (0.35 SD units lower; 95% confidence interval, 0.24–0.46). CONCLUSIONS: Among adolescents, greater daytime sleepiness and greater eveningness chronotype were independently associated with lower self-regulation, but shorter sleep duration was not. Aspects of sleep other than school-night sleep duration appear to be more strongly associated with self-regulation. a Division of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts; bCenter for WHAT’S KNOWN ON THIS SUBJECT: Chronic sleep Obesity Research and Education and Departments of eEpidemiology and Biostatistics and fPediatrics, Temple loss in adolescents has been linked to impaired self- University, Philadelphia, Pennsylvania; and Divisions of cPulmonary and Sleep Medicine and dNeuropsychology, regulation and increased risk of adverse health and Children’s National Medical Center, George Washington University School of Medicine, Washington, District of functional outcomes. However, less is known about Columbia how self-regulation is related to daytime sleepiness Dr Owens helped design the data collection instruments and procedures, conceptualized and and circadian phase preference (chronotype). designed the analyses in this study, drafted sections of the manuscript (Introduction and Discussion), and made critical revisions to the manuscript; Dr Dearth-Wesley managed the WHAT THIS STUDY ADDS: Among adolescents, daytime data and conducted the statistical analyses, assisted Dr Whitaker in the development of the sleepiness and a more “eveningness” chronotype (ie, manuscript tables and fi gures, and made critical revisions to the manuscript; Dr Lewin helped tendency for later sleep onset and offset and timing design the data collection instruments and procedures, participated in the data collection, and of activity patterns) are both stronger predictors made critical revisions to the manuscript; Dr Gioia provided expert guidance on the application of poor self-regulation than is short nighttime sleep of the self-regulation measures and made critical revisions to the manuscript; Dr Whitaker duration. helped design the data collection instruments and procedures, conceptualized and designed the To cite: Owens JA, Dearth-Wesley T, Lewin D, et al. Self-Regulation and Sleep Duration, Sleepiness, and Chronotype in Adolescents. Pediatrics. 2016;138(6):e20161406 Downloaded from www.aappublications.org/news by guest on September 25, 2021 PEDIATRICS Volume 138 , number 6 , December 2016 :e 20161406 ARTICLE Insufficient sleep has reached more than insufficient sleep. For were independently associated with epidemic levels among adolescents example, chronotype, or circadian- self-regulation in a large community- in the United States 1 – 7 and in other based morningness–eveningness based sample of middle and high nations. 8 – 12 Chronic sleep loss in preference (ie, the tendency to be school students. We secondarily teenagers is now considered a public a “morning lark” or “night owl”) is examined the relationship between health problem by leading advocates another aspect of sleep regulation these dimensions of sleep and 3 for children’s health, including the that may independently influence domains of self-regulation: cognitive, American Academy of Pediatrics, 13 self-regulation. A pronounced shift to emotional, and behavioral. the American Medical Association, a more evening chronotype coincides 14 and the US Department of Health both with increased age and pubertal and Human Services, 15 because of development in adolescents. 47 – 50 METHODS its potential adverse impacts on Given that evening types cannot To determine how nighttime sleep adolescent cardiometabolic health, 16 – 19 easily fall asleep earlier at night and duration, daytime sleepiness, and mental health, 20 – 24 substance must still meet societal demands chronotype predict self-regulation, use, 25 – 27 safety, 28 – 33 and academic to wake up and function early in we used data from an online survey performance. 34, 35 the morning, this often results in a of students (grades 7–12) and sleep duration that is insufficient to Impaired self-regulation may be 1 parents, which was conducted meet sleep needs. Moreover, timing mechanism by which insufficient between March and June 2015 in of activity and alertness patterns sleep leads to adverse effects Fairfax County Public Schools. Fairfax during the day are also shifted later on health and functioning. Self- is the 11th largest school district in in these people. This misalignment regulation is the “act of managing the United States, serving a diverse of circadian biology and societal cognition and emotion to enable goal- community in the northern Virginia demands has been called “social jet directed actions such as organizing suburbs of Washington, District of lag.”51, 52 Eveningness is also a risk behavior, controlling impulses, and Columbia. factor in adolescents for a number solving problems constructively.” 36 of conditions that have also been Three interrelated domains are Survey Design associated with poor self-regulation: involved in self-regulation: cognitive emotional and behavioral The survey was made available to (eg, executive functioning and goal problems, 53 –56 substance abuse, 57 all students (and their parents) setting), emotional (eg, emotional obesity, 58 health risk behaviors, 52, 59,60 in 19 schools: 8 of 23 middle awareness and management), and and lower school performance. 61 – 64 schools (grades 7–8), 8 of 24 high behavioral (eg, impulse control and These findings suggest that a broader schools (grades 9–12), and all 3 delay of gratification). Self-regulation conceptualization of deficient sleep in secondary schools (grades 7–12). is governed by a number of brain adolescents that involves problematic The 19 schools were selected to regions such as the prefrontal cortex, timing and duration of sleep may be be representative of the entire amygdala, and ventral striatum, a useful construct in assessment of district with regard to student race which are undergoing profound functional outcomes such as impaired and ethnicity and family income. developmental changes during self-regulation. The survey design addressed the adolescence 37, 38 and whose function need to protect class time (no is adversely affected by insufficient Finally, 2 cross-sectional studies in-class administration), minimize sleep. 39– 41 of adolescents found that self- disruptions (no direct e-mail or regulation was associated with Short-term experimental sleep cell phone contact with students daytime sleepiness (an increased manipulation in young children, 42, 43 by the research team), and obtain propensity to fall asleep in school-age children, 44, 45 and parent consent. Parents (or primary inappropriate circumstances and adolescents46 acutely affects self- caregivers) at each of the study difficulty maintaining alertness, regulation and the performance schools received an initial invitation which interferes with activities of of complex tasks. Although to participate in the study via a daily living) but not nighttime sleep impaired self-regulation has also district-sponsored e-mail, followed duration. 65, 66 However, neither been observed in the context of by 3 reminders. Parents were asked study examined the contribution of “naturalistic” chronic sleep loss, to grant electronic consent for their chronotype to self-regulation. on a level experienced by many child to participate and to complete adolescents, there is some evidence The purpose of this study was to an online parent survey. Students that the relationship between sleep determine whether 3 distinct aspects with parental consent were sent a and functional impairments related of sleep, nighttime sleep duration, link via e-mail to a separate online to poor self-regulation involves daytime sleepiness, and chronotype, student survey. Upon completion of Downloaded from